'A call handler thought Barbados was in West Africa'

I’m [most] concerned about the large number of inappropriate 999 calls and diversions to go to A&E that NHS 111 recommends

The funniest example of 111 I have experienced was reading a transcript of an encounter one of our patients had when the ebola epidemic was rife in West Africa. She was a 19-year-old female with a 24-hour history of diarrhoea and vomiting.

The 111 algorithm asked ‘has the patient returned from West Africa recently?’, to which the call handler typed in ‘Yes - Barbados’ and the patient was then advised to attend her local A&E department asap!

I also found the stat given in the winter A&E crisis last year interesting, that A&E attendances had increased by 250,000 that year, which almost exactly equalled the number of patients being sign-posted to A&E by 111, along with the number of ambulances called by 111.

Dr Bharat Nanavati, GP in central Manchester:

We need to be rid of NHS 111. It is no better if not worse than NHS Direct.

Incidentally, in this morning’s post: 21-yr-old woman with heavy painful vaginal bleeding for 30 minutes. Concluded by NHS 111 as: ‘the individual needs to attend an emergency treatment centre within one hour’, ‘the assessment ended because the caller refused an ambulance disposition, can ring for someone to take to A&E?’

An ambulance for a heavy, painful period? No wonder the A&E is in a mess! I have no doubt that the young lady was seeking no more than telephone advice and refused the utterly stupid recommendations of the NHS 111.’

Dr James Cherry, locum and out-of-hours GP in Mid and West Cheshire:

NHS 111 is hopeless and dangerous, diverts ambulances away from genuine emergencies and clogs up A&E. It is all to do with the 111 call handler algorithm in which ‘red-flag symptoms’ trigger an often excessive response.

A typical scenario could be: wife of 45-year-old man rings 111 on a weekend or evening wanting advice as to whether her husband needs to be seen with flu-like symptoms or if it could wait until his GP surgery opens. She mentions that he has some chest discomfort, aches and pains and 111 calls out an emergency ambulance. Meanwhile, no ambulance is available for a genuine emergency.

Dr Mario Carl Wildenauer, out-of-hours GP in Oxfordshire:

NHS 111 is a complete waste of everybody’s time, resources and money that would be invested much better in people doing the work and not producing completely superfluous work to the clinicians and a lot of anxiety and anger to our patients and their families.

Their unanimous judgement is that nobody was listening to what they tried to tell 111, 111 mercilessly went on with their ‘idiotic questions’ (original tone of our patients), up to the point to ask repeatedly over 80-year-old patients if they were pregnant (most of them feeling insulted, and asking if we are in a mad house, the simple answer to which is ‘yes’), including a gentleman over 80, with first name John and a really deep voice, who took it from the funny side and laughed his socks off.

The only solution is to abolish this useless service and their inventors and promotors. I wonder what they get out of doing so, certainly not anything in favour of our patients or a better service to them.

Ambulances sent to earaches and toothaches (usually life threatening!) and not available for heart attacks and strokes, sometimes classified by 111 as ‘routine’ despite of documented previous history of heart attack and all classical symptoms, is only one of the many gifts of 111 to the NHS. No, thank you.

Dr Frankie Lasman, GP in Huntingdon:

To be honest, I don’t take any notice of any referrals from 111 as they are mostly such nonsense that I assess everyone from scratch anyway.

Our area does however have a pilot looking at GPs taking calls rather than the 111 numpty system asking a list of stupid questions, which seems sensible. If we are to stem demand we need people to go back to self care.

The current system encourages everyone to call a professional ‘just in case’. The over-defensive nature of the 111-‘can’t miss anything which might remotely indicate something wrong’-system (and other systems where people use protocols rather than knowledge and common sense) means that far more people are sent to A&E than needed.

Dr Chris Kenyon, GP in Oxford:

I despise NHS 111 with every fibre of my being. Not only is it no replacement for an intelligent conversation (at least on one side) between an experienced clinician and a patient, it is an entity which panders to the inappropriate consumerist sense of entitlement to anything anytime (for nothing) and it is the creator of anxiety and totally useless clinical activity which removes resources from what really needs to be done, It is expensive, harmful and a major insult to professional integrity.

The thing to remember about 111 is they do not refer, they dispose a call. They do not tell people what is wrong with them but tell them where they can go to get an assessment and then within a timeframe.

So if I phone with a simple cold and tell them I am short of breath when I am coughing then the algorithm will focus on [this] and say GP within two hours instead of ‘you have a cold, cough medicines do not work, here are a list of red flags, see someone if you have these otherwise buy some tissues’ which I think is better [advice].’

Dr Paul Frisby, GP in Eastbourne:

While it is true in my experience that NHS 111 direct a lot of patients unnecessarily to the out-of-hours GP service, which is lamentable, the cost of those contacts is relatively small because of the chronic under-funding of primary care services and the shoestring budgets for out-of-hours care and general practice. I was recently working with a paramedic practitioner who told me that he gets many inappropriate referrals directly from 111.

The difference with these cases is that dispatching an ambulance or paramedic car is immediately a much more expensive intervention than sending a GP (perhaps 10 times as much), and could be more likely to result in the patient being transferred to the A&E department (the paramedic isn’t able to absorb as much risk as the GP can as they have stricter protocols to follow).

Dr Au Iqbal, out-of-hours GP in the West Midlands:

Most are inappropriately triaged or graded as urgent when they are not.

Dr Joe McGilligan, GP in Redhill, Surrey:

Always safety netting which is good. Once they have access to patients notes it will be better and safer.

I was on the front page of the Telegraph a few years back for suggesting 111 could book GP appointments so everything takes years to bed in and people gain confidence in. There is no perfect solution but this is at least now joined up between 999 and out of hours.

if we criticize without offering a solution then our masters will come up with something worse. remember there was criticism of nhsdirect? from that 111 was born. if that goes we will have to shoulder the entire demand as there will be calls for GPs to take back all OOH as pre-2004. given that their is greater expense and much greater risk we are heading to a scenario where things are going to be 10 x worse than pre-2004.